Comparison of the efficacy of selecting sperm with normal nuclei by high magnification for intracytoplasmic sperm injection (ICSI) according to age in refractory in vitro fertilization (IVF) cases.

摘要

PURPOSE: To determine the pregnancy rates according to age in women failing to conceive after three previous embryo transfers or having a husband whose sperm shows a DNA fragmentation index (DFI) > 30% when performing the sperm chromatin structure assay. METHODS: Women up to age 45 were included and there was no restriction for low egg reserve. Live delivered pregnancy rates were determined according to three age groups: < or =34, 35-38, 39-45. The data were also analyzed in a group comparable to previous publications using high magnification ICSI, i.e., younger women with normal egg reserve. Pregnancy rates following frozen embryo transfer were also evaluated. RESULTS: Using all 86 in vitro fertilization-embryo transfer (IVF-ET) cycles the live delivered pregnancy rates were 40% (10/25) for women < or = age 34, 24% (6/25) in women age 35-38, and 13.8% in women aged 39-45. Evaluating the younger group with normal egg reserve with > or =3 previous failed IVF-ET cycles the live delivered pregnancy rate per transfer was 38% (16/42). If one adds the additional six live deliveries from subsequent frozen embryo transfer (6 of 17, 35.3%) this group of women had a 52.3% (22/42) live delivered pregnancy rate from one egg retrieval. CONCLUSIONS: These data were uncontrolled and thus conclusions should be viewed with caution. The results are sufficiently encouraging to warrant a prospective controlled trial and possibly encourage a company to consider commercially manufacturing high magnification microscopes.